Objective:To study the factors influencing survival after radical resection in patients with intrahepatic cholangiocarcinoma (ICC), and to construct a nomogram on survival prediction.Methods:The clinical data of 139 patients with ICC who underwent radical resection at the People's Hospital of Zhengzhou University from June 2018 to December 2021 were retrospectively analyzed. There are 69 males and 70 females, aged (59.5±10.2) years old. These patients were divided into two groups based on a 3: 1 ratio by using the random number method: the test group ( n=104) and the validation group ( n=35). Data from the test group was used to construct a nomagram and data from the validation group was used to validate the predictive power of the nomagram. Univariate and multivariate Cox regression analyses were used to analyse factors influencing survival on the test group patients and to construct a nomogram. The predictive accuracy of the nomogram was determined by receiver operating characteristic (ROC) curves, concordance index (C-index) and calibration curves. Results:The results of the multivariate regression analysis showed that a combined hemoglobin, albumin, lymphocyte and platelet immunoinflammation (HALP) score <37.1 ( HR=1.784, 95% CI: 1.047-3.040), CA19-9 > 35U/ml ( HR=2.352, 95% CI: 1.139-4.857), poorly differentiated tumor ( HR=2.475, 95% CI: 1.237-4.953) and vascular invasion ( HR=1.897, 95% CI: 1.110-3.244) were independent risk factors that affected prognosis of patients with ICC after radical resection (all P<0.05). The AUCs of the nomogram in the test group in predicting the overall survival at 1, 2 and 3 years of patients with ICC after radical resection were 0.808, 0.853 and 0.859, respectively. There was good consistency between the prediction of the nomogram and actual observation. The predicted C-index of the total survival period of the test group was 0.765 (95% CI: 0.704-0.826), and the C-index of the validation group was 0.759 (95% CI: 0.673-0.845). Conclusion:A HALP score <37.1, CA19-9>35 U/ml, poorly differentiated tumour and vascular invasion were independent risk factors for prognosis of ICC patients after radical resection. The nomogram was established based on the above factors and showed good performance in predicting overall survival after radical resection in patients with ICC.

目的 分析老年肝胆外科手术患者术后肺部并发症(PPCs)与膈肌功能的关系.方法 收集解放军总医院第二医学中心综合外科行肝胆外科手术的16例老年患者的临床资料.根据术后是否出现肺部并发症分为PPCs组(6例)和非PPCs组(10例).应用床旁超声分别于术前1天、术后当天、术后第1天、术后第3天及术后第7天监测患者右侧膈肌移动度(DE).比较2组患者术前DE、术后最小DE、ΔDE、手术时间及手术方式的差异.采用SPSS 23.0统计软件进行数据分析.采用多因素logistic回归分析影响PPCs的危险因素,并绘制受试者工作特征(ROC)曲线评价其对PPCs的预测价值.结果 2组患者术前DE及手术方式比较,差异无统计学意义(P>0.05).与非PPCs组相比,PPCs组患者手术时间更长[(247.500±68.099)和(162.300±66.111)min]、术后最小DE更小[(1.071±0.202)和(1.414±0.236)cm]、ΔDE更大[(0.536±0.106)和(0.343±0.139)cm],差异均有统计学意义(均P<0.05).多因素logistic回归分析显示,手术时间及术后最小DE是影响PPCs的独立危险因素.手术时间及术后最小DE预测PPCs的ROC曲线下面积分别为0.825(95％CI 0.670～0.980)和0.867(95％CI 0.693～0.974),最佳截断点分别为210min和1.19cm,灵敏度分别为83.33％和90.00％,特异度分别为80.00％和83.33％.结论 术后膈肌功能下降及长时间手术是影响老年肝胆外科手术患者PPCs的危险因素,可通过膈肌超声监测膈肌功能对PPCs进行预测.

Objective To explore the technical knowhow and experience of mesohepatectomy for central region liver disease.Methods The clinical data of 86 patients with liver disease in central region undergoing mesohepatectomy were retrospectively analysed in Henan Provincial People's Hospital,including 49 males and 37 females.There were 47 cases of central liver cancer,15 cases of hilar cholangiocarcinoma,4 cases of hepatic hemangioma,13 cases of gallbladder cancer,and 7 cases of intrahepatic cholangiolithiasis in central liver.25 cases received accurate hepatectomy (group A) and 61 cases did irregular hepatectomy (group B).Results In group A,15 cases did Ⅳ,Ⅴ and Ⅷ lobectomy,10 cases underwent Ⅳ and Ⅴpartial lobectomy.Among the irregular hepatectomy group (group B),35 were treated with hepatic middle lobe resection,26 with local middle liver resection.There were significant differences in operation time,degree of postoperative liver function damage between the two groups (P ＜ 0.05),while there was no difference in postoperative complications (P ＜ 0.05).Conclusions The accurate mesohepatectomy can reduce the incidence of postoperative liver function damage and surgical complications.